PSYCHOSOCIAL PREDICTORS AND THEIR CONNECTION WITH THE QUALITY OF LIFE OF PATIENTS WITH ISCHEMIC HEART DISEASE

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According to data of the European cardiologic association, the psychosocial risk factors act as a barrier for the treatment of cardio-vascular diseases (CVD). The established psychobiological mechanisms are directly included in the pathogenesis of CVD. The social isolation, continuous stress, depression and anxiety are considered predictors and consequences of the cardiac disease [8]. In the scientific circles there are more and more discussions about the expansion of the traditional criteria for assessment of the health results. New variables are included, such as psychoemotional status, social adaptation, health well-being, etc. The contemporary concepts in the psychology of health are focused on searching the interrelation between the psychosomatic predisposition, personal features and the disease.

Thanks to the activity of the World Health Organization and the international scientific societies there is profound experience in the prophylactics and the approaches for reduction of CVD. The good policies and practices are not widely applied in our country. Those disturbing tendencies impose a health policy offering fast decisions and measures for improvement of the efficiency of the prophylactics and the health promotional interventions [1].

The purpose of this development is to analyze some personal factors related to the quality of life of patients with ischemic heart disease (IHD).

Methods: 146 people with ischemic heart disease – chronic form were questioned. The survey was conducted through direct individual questionnaire containing three panels:

A generic questionnaire for self-assessment of the quality of life EuroQol EQ-5D, consisting of five dimensions: mobility, self-care, usual activity, pain/discomfort, anxiety/depression.

A questionnaire for study of type D personality (DS-14 scale), containing 14 questions grouped in two dimensions: negative affection and social isolation.

An adapted questionnaire for assessment of personal anxiety – Trait Anxiety Inventory. The evaluation of the answers is performed under a 4-point Likert scale: never, seldom, often, always.

The database has been created using the SPSSv.19 statistical package. The grouping of the cases in the excerpt has been carried out under the „I“ — logic using filtering of the variables. The data have been processed using analysis of frequency allocations, alternative analysis, quick test of working hypothesis with the Pearson criterion χ2, graphic analysis and precise Fisher’s test.

Results and discussion

The studied respondents have been divided into groups depending on the form of IHD and the duration of the disease. The persons with stable stenocardia are 65 (44.52%), with disorders in the cardiac rhythm and conductivity – 35 (24%); painless form of myocardiac ischemia – 46 (31.50%). 89 of them have arterial hypertension and duration of the disease over 5 years, from whom 49 are women (67.1%) and 40 are men (54.8%). The distribution of the respondents by gender and age is as follows: men – 73, average age 60.17±2.48; women 73, average age 64.27±2.78. The relative share is the highest in patients living in the cities, married, retired and with secondary education (see table 1).

Table 1. Distribution of the respondents by sociodemographic indicators.

indicators

male

female

N

р %

Sp

N

р %

Sp

Place of residence

village

14

19,18

4,61

15

20,55

4,73

city

41

56,16

5,81

41

56,16

5,81

regional city

18

24,66

5,04

17

23,29

4,95

Total

73

100,00

73

100,00

Marital status

married

48

65,75

5,55

38

52,05

5,85

single

14

19,18

4,61

9

12,33

3,85

widow(er)

11

15,07

4,19

26

35,62

5,60

Total

73

100,00

73

100,00

Education

higher

22

30,10

5,37

24

32,88

5,50

secondary

44

60,30

5,73

38

52,05

5,85

primary

7

9,60

3,45

11

15,07

4,19

Total

73

100,00

73

100,00

Occupation

employed

28

38,40

5,69

24

32,88

5,50

Occupation

6

8,20

3,21

5

6,85

2,96

retired

39

53,40

5,84

44

60,27

5,73

Total

73

100,00

73

100,00

Anxiety is a sign of emotional instability of the individual and its importance for coping with the disease is underestimated by the medical specialists. Copying of anxiety may lead to a change from risk behaviour to establishment of trust and consent of the patient with the treatment process. Аt the same time the social inclusion, anxiety and personal characteristics are important predictors for development of cardio-vascular diseases [11, 12].

The results of the studied group of patients show anxiety in 72 (49.3%). From them 39 are men (53.42%) and 33 women (45.20%). The average values from the test for anxiety show results above the norm in the male group (table 2).

Table 2. Average state-trait anxiety inventory (STAI) of the respondents by gender.

gender

mean

SD

min

max

male

44,41

9,16

29

72

female

47,16

8,86

26

65

total

45,79

9,09

26

72

There proved to be a connection between anxiety and place of residence of the respondents (χ2=8,97, df=2, р=0,011); anxiety and educational level (χ2=9,53, df=2, р=0,009); anxiety and employment (χ2=14,68, df=2, р=0,001); anxiety and age (χ2=9,55, df=2, р=0,008). Anxious predisposition is predominantly typical of individuals from small urban areas 20 (60.0%); single 13 (56.5%), with primary education 13 (72.2%); at the age of retirement 52 (62.7%). There was no dependency between anxiety and gender (χ2=0,98, df=1, р=0,321); anxiety and marital status of the patients (χ2=1,32, df=2, р=0,509).

Results from other studies show that depression and anxiety are the most significant factors of the quality of life in patients with cardio-vascular diseases. There is a tendency of avoidance of physical activity, increase in the severity of the somatic symptoms and the emotional significance of the cardiac disease. Moreover, the female patients need more serious social support due to the reported more negative results of the quality of life and social adaptation [5].

The separation of the type D personality from the types A, B and C known so far appears to be continuation of the work of the psychologists from the end of 20th century conceptualizing the relation between the specific personal characteristics and health. As a result of empirical studies of patients with cardiological diseases, the Dutch scholar J. Denollet defines a fourth type of personality – type D, which tends to form chronical stress. People of this type are distinguished for their „negative excitement“, a tendency to express negative emotions, anxiety, sorrow, pessimism. They are predominantly restrained in their emotional expression, show secrecy and develop low self-confidence. J. Denollet confirms the importance of the combination of negative excitement and social inhibition for determination of an increased rik of cardiac incident. This gives the scholars a reason to assume that the state of mind is a key factor for the health of the heart, along with the diet, exercises and external stress [3, 4].

The average number of points from the test for type D personality from both dimensions is 22,73±10,18. Values above the standard were found in 83 (56.8%) of the patients. A connection between anxiety and type D personality was reported in both dimensions: negative affection (χ2=34,21, df=1, р=0,001) and social isolation (χ2=15,90, df=1, р=0,001). The individuals with anxious attitude and negative affection are 62 (86,11%), and the patients with anxiety and feeling of social insulation are 43 (59,72%) respectively. There was a dependency between the gender and social inhibition (χ2=8,06, df=1, р=0,005). A connection between gender and the dimension of negative affection was not observed (χ2=0,72, df=1, р=0,39). The place of residence and marital status are related to individuals showing a negative tendency in their behaviour (χ2=7,21, df=2, р=0,02); (χ2=6,72, df=2, р=0,03).

There was a connection between the two dimensions of type D personality and the dimensions from the questionnaire related to the quality of life EQ-5D. There is a dependency between the persons communicating problems in the quality of lice and those belonging to the type D personality. The results are presented in table 3.

Table 3. A connection between the dimensions of type D personality and the dimensions of quality of life.

Type D personality

EQ-5D — dimensions

Negative affectivity

Social inhibition

mobility

χ2=13,0 df=1 р=0,001

χ2=20,44 df=1 р=0,001

self-care

χ2=7,32 df=1 р=0,007

χ2=3,76 df=1 р=0,052

usual activity

χ2=21,71 df=1р=0,001

χ2=16,66 df=1 р=0,001

pain/discomfort

χ2=11,18 df=1р=0,001

χ2=8,51 df=1 р=0,003

Analogous results were described in a study carried out by N. Orinska-Bulic (2014]. Type D personality was found in 46.5% of the instances of the excerpt. The patients show low quality of life in comparison to the group not belonging to type D. From both dimensions social inhibition has been identified as a predictor of the bad quality of life [9].

Ferketich and Ferguson (2005) found out that some variables: reduced physical functioning, anxiety, social isolation and somatization are part of the evidence for a possible causal relationship between the already existing depression and the potential for development of a cardio-vascular disease [8].

The surveys of D. Todorova-Papancheva and H. Silgidzhiyan (2011) among patients with ischemic heart disease also confirm the significance of the connection between the CAD-specific correlations: low adaptivity and depression, as well as the typical manifestations of the type D personality and their mutual influences. Those results correspond to the last international studies in this area. They distinctly outline the specifications of type D personality in the studies persons, parallel to the depressive symptoms [2].

The obtained results of the quality of life of the studied group through the questionnaire EQ-5D shows dependency between age and four of the five dimensions: mobility (χ2=11,83, df=5, р=0,037); self-care (χ2=16,83, df=5, р=0,005); usual activity (χ2=18,89, df=5, р=0,002); pain/discomfort (χ2=12,54, df=5, р=0,028). There is a larger relative share in individuals over the age of 60, which show availability of express problems in the areas: pain/discomfort, physical activity and coping with various activities (Fig. 1).

Figure 1. Distribution of the studied contingent by dimensions (EQ-5D), reported problems and age groups.

The health behaviour expressed in regular physical activity, as well as observation of the therapeutic regime are identified as clinically significant predictors of better life [6].

In the last years there is an increased interest of the researchers towards establishment of a connection between the psychological factors and the prognosis for development of a coronary disease. Simultaneously they are working on the application of adequate pshyco-social interventions and efficient cardiological rehabilitation. Those policies confirm the significance of the personal features for the management of the chronic cardio-vascular diseases and the recognition of this factor as equally important with the therapy [10].

Conclusion

A little more than half of the respondents show a tendency towards anxiety, pessimism and negative expression in their behaviour. At the same time the feeling of health and quality of life are related to problems in the activity, the ability to cope with the everyday life and the symptoms of the disease.

The role of the personality for the development of a cardio-vascular disease is not sufficiently studied. The health results show that the observation of an appropriate regime and diet are not sufficient for the treatment. The significance of the type of personality and the psycho-emotional resources for coping with the disease have been identified as an important component of the compnlex client-centered health care.

On the other hand, the subjective assessment of personal health and well-being have an outlined protective effect both with respect to the development of IHD and the reactivity to stress and occurrence of a coronary incident. The study of those phenomena is connected with the development of rational strategies for stratification of the associated risk, as well as algorithms of treatment and prevention.

PSYCHOSOCIAL PREDICTORS AND THEIR CONNECTION WITH THE QUALITY OF LIFE OF PATIENTS WITH ISCHEMIC HEART DISEASE

In the last years there is an increased interest of the researchers towards establishment of a connection between the psychological factors and the prognosis for development of a coronary disease. The purpose of this development is to analyze some personal factors related to the quality of life of patients with ischemic heart disease. The psychosocial factors, the physical condition and the environment have a major influence on the quality of life of patients with chronic ischemic heart disease. The significance of the type of personality and the psycho-emotional resources for coping with the disease have been identified as an important component of the compnlex client-centered health care.